{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T07:23:58Z","timestamp":1762068238790,"version":"build-2065373602"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T00:00:00Z","timestamp":1664409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The aim of this study is to evaluate the correlation between body mass index (BMI) and body fat composition (measured with radiological fat parameters (RFP)) and pathological response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer patients. The secondary aim of the study was to assess the role of BMI and RFP on major surgical complications, overall survival (OS), and disease-free survival (DFS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients who underwent surgical resection following nCRT between 2005 and 2017 for mid-low rectal cancer were retrospectively collected. Visceral fat area (VFA), superficial fat area (SFA), visceral\/superficial fat area ratio (V\/S), perinephric fat thickness (PNF), and waist circumference (WC) were estimated by baseline CT scan. Predictors of pathologic response and postoperative complications were investigated using logistic regression analysis. The correlations between BMI and radiologic fat parameters and survival were investigated using the Kaplan\u2013Meier method and log-rank test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of 144 patients included, a complete (TRG1) and major (TRG1+2) pathologic response was reported in 32 (22%) and 60 (45.5%) cases, respectively. A statistically significant correlation between BMI and all the RFP was found. At a median follow-up of 60 (35\u2013103) months, no differences in terms of OS and DFS were found considering BMI and radiologic fat parameters. At univariable analysis, neither BMI nor radiologic fat parameters were predictors of complete or major pathologic response; nevertheless, VFA, V\/S&amp;gt;1, and BMI were predictors of postoperative major complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found no associations between BMI and body fat composition and pathological response to nCRT, although VFA, V\/S, and BMI were predictors of major complications. BMI and RFP are not related to worse long-term OS and DFS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.994444","type":"journal-article","created":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T07:55:11Z","timestamp":1665042911000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Obesity may not be related to pathologic response in locally advanced rectal cancer following neoadjuvant chemoradiotherapy"],"prefix":"10.3389","volume":"12","author":[{"given":"Quoc Riccardo","family":"Bao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Crim\u00ec","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Valotto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Chiminazzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Bergamo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra Anna","family":"Prete","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Galuppo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Badr","family":"El Khouzai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilio","family":"Quaia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore","family":"Pucciarelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele Damiano Luca","family":"Urso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.30805","article-title":"What has preoperative radio(chemo)therapy brought to localized rectal cancer patients in terms of perioperative and long-term outcomes over the past decades? A systematic review and meta-analysis based on 41,121 patients","volume":"141","author":"Ma","year":"2017","journal-title":"Int J Cancer"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-304701","article-title":"Obesity and colorectal cancer","volume":"62","author":"Bardou","year":"2013","journal-title":"Gut"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.15.6687","article-title":"Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: Findings from cancer and leukemia group b 89803","volume":"26","author":"Meyerhardt","year":"2008","journal-title":"J Clin Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.12.020","article-title":"Circulating levels of insulin-like growth factor 1 and insulin-like growth factor binding protein 3 associate with risk of colorectal cancer based on serologic and mendelian randomization analyses","volume":"158","author":"Murphy","year":"2020","journal-title":"Gastroenterology"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2017.07.022","article-title":"Impact of body mass index on treatment outcome of neoadjuvant chemoradiotherapy in locally advanced rectal cancer","volume":"43","author":"Sun","year":"2017","journal-title":"Eur J Surg Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0000000000000150","article-title":"Oncologic and functional hazards of obesity among patients with locally advanced rectal cancer following neoadjuvant chemoradiation therapy","volume":"40","author":"Park","year":"2017","journal-title":"Am J Clin Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3857\/roj.2016.01725","article-title":"Association between obesity and local control of advanced rectal cancer after combined surgery and radiotherapy","volume":"34","author":"Choi","year":"2016","journal-title":"Radiat Oncol J"},{"key":"B8","article-title":"Obesity is a risk factor for multifocal disease and recurrence after colorectal cancer surgery: A case-control study","volume":"34","author":"Scarpa","year":"2014","journal-title":"Anticancer Res"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2013.64","article-title":"The GH\/IGF-1 axis in obesity: pathophysiology and therapeutic considerations","volume":"9","author":"Berryman","year":"2013","journal-title":"Nat Rev Endocrinol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i43.16268","article-title":"Insulin-like growth factor receptor-1 overexpression is associated with poor response of rectal cancers to radiotherapy","volume":"20","author":"Wu","year":"2014","journal-title":"World J Gastroenterol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-018-3065-z","article-title":"Higher visceral fat area\/subcutaneous fat area ratio measured by computed tomography is associated with recurrence and poor survival in patients with mid and low rectal cancers","volume":"33","author":"Lee","year":"2018","journal-title":"Int J Colorectal Dis"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12234","article-title":"Sarcopenia is negatively associated with long-term outcomes in locally advanced rectal cancer","volume":"9","author":"Choi","year":"2018","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-012-2045-9","article-title":"Visceral obesity and colorectal cancer: are we missing the boat with BMI","volume":"17","author":"Rickles","year":"2013","journal-title":"J Gastrointest Surg"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-008-9891-4","article-title":"Visceral obesity may affect oncologic outcome in patients with colorectal cancer","volume":"15","author":"Moon","year":"2008","journal-title":"Ann Surg Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S216034","article-title":"Predictive role of body composition parameters in operable breast cancer patients treated with neoadjuvant chemotherapy","volume":"11","author":"Omarini","year":"2019","journal-title":"Cancer Manag Res"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2017.04.001","article-title":"The effect of obesity on pathological complete response and survival in breast cancer patients receiving uncapped doses of neoadjuvant anthracycline-taxane-based chemotherapy","volume":"33","author":"Farr","year":"2017","journal-title":"Breast"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e31828e5a72","article-title":"CEA - a predictor for pathologic complete response after neoadjuvant therapy for rectal cancer","volume":"56","author":"Wallin","year":"2013","journal-title":"Dis Colon Rectum"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003051","article-title":"Microsatellite instability (MSI) as an independent predictor of pathologic complete response (PCR) in locally advanced rectal cancer: A national cancer database (NCDB) analysis","volume":"271","author":"Hasan","year":"2020","journal-title":"Ann Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21388","article-title":"The eighth edition AJCC cancer staging manual: Continuing to build a bridge from a population-based to a more \u201cpersonalized\u201d approach to cancer staging","volume":"67","author":"Amin","year":"2017","journal-title":"CA: A Cancer J Clin"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19940601)73:11<2680::aid-cncr2820731105>3.0.co;2-c","article-title":"Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma","volume":"73","author":"Mandard","year":"1994","journal-title":"Clinicopathol Correlations Cancer"},{"key":"B21","unstructured":"National comprehensive cancer network. rectal cancer (Version 1.2022)2022"},{"key":"B22","unstructured":"Linee guida NEOPLASIE DEL RETTO e ANO2021"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-017-1665-1","article-title":"Rectal sparing approach after preoperative radio- and\/or chemotherapy (RESARCH) in patients with rectal cancer: a multicentre observational study","volume":"21","author":"Barina","year":"2017","journal-title":"Tech Coloproctol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2018.11.023","article-title":"The INTERACT trial: Long-term results of a randomised trial on preoperative capecitabine-based radiochemotherapy intensified by concomitant boost or oxaliplatin, for cT2 (distal)-cT3 rectal cancer","volume":"134","author":"Valentini","year":"2019","journal-title":"Radiother Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-020-09243-6","article-title":"Long-term outcomes of local excision following neoadjuvant chemoradiotherapy for locally advanced rectal cancer","volume":"28","author":"D'Alimonte","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114510000796","article-title":"Computed tomography-based validation of abdominal adiposity measurements from ultrasonography, dual-energy X-ray absorptiometry and anthropometry","volume":"104","author":"Gradmark","year":"2010","journal-title":"Br J Nutr"},{"key":"B27","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/1748-717X-8-43","article-title":"Carcinoembryonic antigen (CEA) level, CEA ratio, and treatment outcome of rectal cancer patients receiving pre-operative chemoradiation and surgery","volume":"8","author":"Yang","year":"2013","journal-title":"Radiat Oncol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2013.01.007","article-title":"Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation","volume":"216","author":"Clark","year":"2013","journal-title":"J Am Coll Surg"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-1452","article-title":"Measurement of waist circumference: midabdominal or iliac crest","volume":"36","author":"Ma","year":"2013","journal-title":"Diabetes Care"},{"volume-title":"R: A language and environment for statistical computing","year":"2022","key":"B30"},{"key":"B31","unstructured":"HarrellFEJr\n          Rms: Regression modeling strategies2020"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-019-04163-1","article-title":"Metabolic syndrome, as defined based on parameters including visceral fat area, predicts complications after surgery for rectal cancer","volume":"30","author":"Zhou","year":"2020","journal-title":"Obes Surg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1159\/000486143","article-title":"Influence of visceral fat in the outcomes of colorectal cancer","volume":"36","author":"Goulart","year":"2019","journal-title":"Dig Surg"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2010.03.012","article-title":"Obesity increases wound complications in rectal cancer surgery","volume":"163","author":"Balentine","year":"2010","journal-title":"J Surg Res"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2016.03.066","article-title":"Visceral obesity, muscle mass and outcome in rectal cancer surgery after neo-adjuvant chemo-radiation","volume":"29","author":"Heus","year":"2016","journal-title":"Int J Surg"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2019.249","article-title":"Association of body composition with long-term survival in non-metastatic rectal cancer patients","volume":"52","author":"Han","year":"2020","journal-title":"Cancer Res Treat"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-022-04204-9","article-title":"The impact of anastomotic leak on long-term oncological outcomes after low anterior resection for mid-low rectal cancer: extended follow-up of a randomised controlled trial","volume":"37","author":"Bao","year":"2022","journal-title":"Int J Colorectal Dis"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003889","article-title":"Oncological outcomes after anastomotic leakage after surgery for colon or rectal cancer: Increased risk of local recurrence","volume":"275","author":"Koedam","year":"2022","journal-title":"Ann Surg"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-4187-3","article-title":"Anastomotic leakage is associated with impaired overall and disease-free survival after curative rectal cancer resection: a propensity score analysis","volume":"22","author":"Kulu","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"B40","unstructured":"Dati epidemiologici"},{"key":"B41","unstructured":"Obesity rate by state2021"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(21)00045-0","article-title":"Epidemiology and determinants of obesity in China","volume":"9","author":"Pan","year":"2021","journal-title":"Lancet Diabetes Endocrinol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.994444\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T07:55:15Z","timestamp":1665042915000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.994444\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,29]]},"references-count":42,"alternative-id":["10.3389\/fonc.2022.994444"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2022.994444","relation":{},"ISSN":["2234-943X"],"issn-type":[{"type":"electronic","value":"2234-943X"}],"subject":[],"published":{"date-parts":[[2022,9,29]]},"article-number":"994444"}}